Mayo Elbow Performance Score Score Research Articles

Distal Biceps Repairs in Females: A Large Single-Center Case Series.

Distal biceps repair is a commonly reported procedure in male patients, with reliable outcomes and minimal long-term complications. Information on female patients, however, is limited, and variation in presentation and clinical outcomes is unknown. We sought to report on the presentation, treatment algorithm, and outcomes of a case series of female patients with distal biceps pathology. A retrospective evaluation was performed from a large, single specialty orthopedic group from 2005 to 2017. Inclusion criteria were surgical treatment of the distal biceps in female patients, with minimum 3 months of follow-up. The primary outcome variable was the Mayo Elbow Performance Score (MEPS). Of 26 patients who met inclusion criteria, 18 (70%) were available for follow-up with patient-reported outcomes. Median age at time of injury was 56.1 years; 46.2% of patients presented with a complete tear of the distal biceps, and the remaining 53.8% presented with a partial tear that failed nonoperative treatment. Six patients had lateral antebrachial cutaneous neuritis in early follow-up, which ultimately resolved. Median MEPS score was 100 (interquartile range: 20). This study represents the largest case series to date describing the presentation, treatment, and outcomes of female patients with distal biceps repair. Women tend to be older than men, have more insidious onset of pain, present with partial tearing, and may benefit from nonoperative treatment. Ultimately, based on this case series we believe distal biceps repair in female patients is a successful operation with minimal complications and high patient satisfaction.

Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up.

To compare the mid-term outcomes in intra-articular distal humerus fracture (AO/OTA type C) treated with either open reduction-internal fixation (ORIF) or total elbow arthroplasty (TEA) in patients older than 75 years and with more than fiveyears of follow-up. Retrospective study including 24 patients (11 TEA vs. 13 ORIF) with a mean age of 82 years and being all females. Results assessed included (1) radiographic measures; (2) functional results: range of motion, Mayo Elbow Performance Score (MEPS), quick-DASH; and (3) complications. TEA group vs. ORIF group achieved a mean flexion of 117° ± 9.6° vs. 106° ± 14°, extension loss of 38° ± 17° vs. 30.8° ± 16°, pronation 75° ± 5° vs. 85° ± 7° and supination 75° ± 4° vs. 70° ± 5°. Mean MEPS score was 71.6 vs. 83.6 (p = .183) and mean quick-DASH was 44.8 vs. 42.6 (p = .789). All 13 patients in the ORIF group demonstrated radiographic signs of bone union and none underwent conversion to TEA. Sixty-three percent of the patients in the TEA group underwent re-operation at an average of 72 months (62.4-75.2 months), including three for periprosthetic fracture and four for implant loosening. Whereas in the ORIF group, 23% of the patients were re-operatedupon excluding olecranon osteotomy hardware, two for stiffness, and one for an olecranon tension band wire failure. Although there were no differences in mid-term functional outcomes between either treatment, our results suggest that the recent trend towards the use of TEA instead of ORIF in the elderly should be re-examined due to the high rate of complications beyond five years of follow-up with TEA.

A Surgical Protocol for Management of Post Traumatic Heterotopic Ossification of Elbow.

Open excision remains the gold standard of treatment for posttraumatic heterotopic ossification (HO) of the elbow. The purpose of this study is to evaluate the functional outcome of early surgical excision done by adhering to a proposed surgical protocol with exclusive posttraumatic HO of the elbow. A retrospective study was conducted with 31 patients (25 males and 6 females) with a mean follow-up of 40.5 ± 27.44months. Excision was done according to our surgical protocol based on the location of HO, associated fractures, stability, need for ulnar nerve transposition, previous operative scar. Improvement in elbow function, Mayo elbow performance score (MEPS) preoperatively and at final follow-up was compared, and statistical analysis was done. Mean flexion-extension arc, supination-pronation arc and MEPS improved by 74.68° ± 29.32°, 26.13° ± 32.93°, 30.48 ± 11.57, respectively. Flexion arc deteriorated by 10.81° ± 10.42° from intraoperative to final follow-up. Improvement at final follow-up was significant in all the cases (P < 0.05). 19 patients had limited HO, and 12 had global HO. Their mean flexion-extension arc increase was 77.63° ± 29.12° and 70° ± 30.3° respectively, and the final mean MEPS score was 96.05 ± 5.16 and 88.75 ± 11.51, respectively. Nine patients had no initial fracture (Group 1), 13 had some fracture (Group 2), nine had a fracture-dislocation of the elbow (Group 3). Their flexion-extension improvement, final MEPS were 88.33° ± 30.82°, 98.33 ± 5, (Group 1); 81.15° ± 16.73°, 92.31 ± 9.27 (Group 2) and 51.67° ± 31.32°, 89.44 ± 9.5 (Group 3), respectively. We had two complications (6.45%). The surgical protocol described here enabled us to achieve good functional results and was in concordance with similar studies done previously. The online version contains supplementary material available at 10.1007/s43465-021-00381-x.

Determination of the patient acceptable symptomatic state after osteocapsular arthroplasty for primary elbow osteoarthritis.

The study aimed (1) to determine patient acceptable symptomatic state (PASS) values for the pain visual analog scale (PVAS), range-of-motion (ROM) scale difference, Mayo Elbow Performance Score (MEPS), and Self-evaluation Elbow (SEE) following osteocapsular arthroplasty for primary elbow osteoarthritis and (2) to determine factors for achieving the PASS. The study analyzed retrospectively collected osteocapsular arthroplasty registry data from January 2010 to April 2019. Fifty patients were evaluated, and anchor questions for deriving PASS values were administered at a 1-year follow-up. PASS values for the PVAS score, ROM difference, MEPS, and SEE score were derived using a sensitivity- and specificity-based approach. Univariate and multivariate logistic regression analyses were performed to determine factors for achieving the PASS. A subgroup comparison analysis based on age was also conducted. The PASS value was 1.0 for the PVAS score, 15° for ROM difference, 75 for the MEPS, and 60 for the SEE score. Older age (≥65 years) showed significantly lower odds ratios for achieving the PASS for the PVAS score (0.888; 95% confidence interval, 0.804-0.981; P = .032) and ROM (0.861; 95% confidence interval, 0.760-0.976; P = .020). Reliable PASS values were derived for the PVAS score, ROM difference, MEPS, and SEE score after osteocapsular arthroplasty. The PASS values defined in this study can be implemented as clinically relevant targets in patients undergoing osteocapsular arthroplasty. An analysis of factors that affect clinical symptom improvement showed that older age (≥65 years) was significantly correlated with lower PASS values for the PVAS score and ROM.

The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions.

Objectives This study aims to evaluate the early- and mid-term shoulder and elbow functions and compare the union rates after the application of single plate and double plate for the treatment of humerus shaft nonunions.Patients and methods This retrospective study included 56 patients (36 males, 20 females; mean age 53.8±9.5; range, 28 to 68 years) treated with double plate (n=25) and single plate (n=31) osteosynthesis between October 2012 and January 2016. Surgical treatment of the nonunion was applied in the fourth month after the fracture at the earliest. Autograft taken from the iliac bone was applied during the surgery in all patients. Evaluation was performed using The University of California at Los Angeles (UCLA) Shoulder Score, Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), Constant Shoulder Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire.Results The mean postoperative follow-up time was 40.7±9.6 (range, 25 to 58) months. No statistically significant difference was determined in respect of time to union, follow-up time, DASH questionnaire score, UCLA Shoulder Score, VAS, MEPS and Constant Shoulder Score after union in the comparison of the two groups (p>0.05). In the examination of postoperative early (three months) recovery phase of shoulder and elbow functions, statistically significant superior scores were obtained in the double plate group for MEPS (double plate median=85 [min 75-max 90], single plate median=75 [min 70-max 85]) and Constant Shoulder Score (double plate median=89 [min 85-max 92], single plate median=81 [min 75-max 90]) (p<0.001).Conclusion There was no statistically significant difference in terms of time to union and union rates between single plate and double plate fixations for surgical treatment of humeral shaft nonunions. However, superior clinical results were obtained in the early recovery phase of shoulder and elbow functions with double plate fixation.

Clinical comparison of management of intra-articular distal humerus fractures with two surgical approaches; TRAP vs Olecranon osteotomy

Background: The aim of this study is to evaluate and compare the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. Methods: Thirty three patients with intra-articular distal humerus fractures were retrospectively analysed. TRAP approach was used in 17 patients (10 males, 7 females; mean age 35.9 years, range 17-70), and olecranon osteotomy in 16 patients (11 males, 5 females; mean age 34.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. Results: The overall mean arc of elbow motion was 108° (range 70°-140°) in the TRAP group, whereas that of the olecranon osteotomy group was 102° (range 70°-130°). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.318, p=0.236, respectively). The overall complication rate was 41.17% in the TRAP group and 56.25% in the olecranon osteotomy group. Conclusion: Intra-articular distal humerus fractures mandates surgical fixation for best functional outcomes. Both TRAP and olecranon osteotomy approaches can be used in the treatment of intra-articular distal humerus fractures. Both approaches yields no significant difference in clinical and functional results for intra-articular distal humerus fracture management.

Clinical results and functional outcome of humeral shaft fractures treated with MIPO technique

Introduction: The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method. The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique. Material and Methods: A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO). Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow. Results: 83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores. Conclusion: Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

Clinical Results of Endoprosthetic Reconstruction in Malignant Tumors Around the Elbow

Purpose: It was aimed to present the clinical and functional results of the patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. Methods: 14 patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor in the elbow circumference between 2011-2018 in our clinic were included in the study. While 4 of the patients were primary tumors (1 fibromixoid sarcoma, 1 leimyosarcoma, 1 multiple myeloma and 1 ewing sarcoma), 10 were distant organ metastases (4 breast cancer, 3 lung cancer, 1 stomach cancer, 1 renal cell cancer and 1 thyroid cancer). Musculoskeletal Tumour Society (MSTS) score and Mayo elbow performance score (MEPS) and survival were evaluated. Results: The minimum follow-up period of the patients was 7 months, and the maximum follow-up period was 55 months. The mean MEPS score of the patients was 67.5 ± 12.0 (range, 45-90), and the mean of the MSTS score was 19.4 ± 2.3 (range, 16-24). Recurrence occurred at follow-up in 3 patients and exitus at follow-up in 7 patients. In this study, the median survival time of the patients was 44 months. The 1-year survival rate was 70.1% while the 3-year survival rate was 54.5%. Conclusion: Pain and functional results are satisfactory in patients who undergo tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. In the future, studies with larger patient series are needed.

Short- to mid-term outcomes of radial head replacement for complex radial head fractures.

BackgroundThe purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes.MethodsTwenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. ResultsAt the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy).ConclusionsRHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems.

ObjectivesTo evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems.MethodsA retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery‐related complications were assessed.ResultsPatients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow‐up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow‐up, a mean improvement of 22.5 (range, 0–55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow.ConclusionWith full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.

ORIF with orthogonal plating in the management of complex distal humerus fractures -A prospective study of 30 patients

Fractures of the distal humerus are quite challenging due to the nature of the fracture. They are compounded by factors such as gross and osteoporosis, especially in the elderly age group. This study was performed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures with orthogonal plating. Thirty patients with complex fractures of the distal humerus who presented between April 2011 to April 2014 were managed with ORIF with orthogonal plating. They were followed up for three years. Functional evaluation was performed using the MEPS (Mayo elbow performance score) and the DASH score (Disabilities of arm, shoulder and hand). The right elbow was more commonly affected, as seen in 16 patients, and the most common mode of injury was road traffic accidents. The average time to fracture union was 11.6 weeks. The mean MEPS score was 88.5±11.6 with 85.6% of patients having a good or excellent outcome, and the mean DASH score was 23.2 points. ORIF with orthogonal plating of complex distal humerus fractures provides a stable fixation construct and gives good functional outcomes to the patient.

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint

BackgroundThe purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. MethodsOne hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7–10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. ResultsFinally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). ConclusionPatient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. Level of evidenceLevel I prognostic randomized controlled trial.

Analysis of Factors Affecting Return to Work After Surgical Treatment in Patients with AO Type C Distal Humerus Fractures.

The purpose of this study is to evaluate the functional results of distal humerus fractures which were treated by open reduction and fixation with pre-contoured angular stable plates in young patients, and investigate whether the patients could return to their pre-injury work and patients' financial conditions while they were not working. The data of 48 patients, ages between 18 and 55years, working in a job and having AO/OTA type C distal humerus fracture were retrospectively evaluated. Mayo Elbow Performance Score (MEPS) was used to determine functional results. Postoperative radiographs were evaluated to determine the rate of union, degenerative changes, malunion and heterotopic ossification. Financial outcome form was constituted by the authors and the patients asked whether she/he could return to their pre-injury works after treatment finished and the financial status of the patients during the treatment and after the treatment. The mean flexion-extension arc was 114° ± 12°(range 85°-135°) and the mean MEPS score was 85 ± 11(range 65-100). The average time to return to work was 6.5 ± 2.4months (3-12months). AO type C2 and C3 fractures and heterotopic ossification negatively affected the functional results and also adversely affected the patients' return to their pre-injury works. 38 (79%) patients returned to pre-injury work and 29 (76%) of them started to work at the same position before the fracture occured. Nine of 38 patients (24%) had to change their positions. Among the 48 patients, 10 patients (21%) could not return to the same work, 7 of them found light duty and 3 of them had not been to work. Although the functional results of surgical treatment of intra-articular distal humerus fractures are good, at the end of the treatment, especially heavy workers may have difficulties in returning to their former works.

POLISH CULTURAL ADAPTATION OF ELBOW ASSESSMENT SCORES: OXFORD ELBOW SCORE, AMERICAN SHOULDER AND ELBOW SURGEONS-ELBOW, MAYO ELBOW PERFORMANCE SCORE AND SUMMARY OUTCOME DETERMINATION QUESTIONNAIRE

Introduction Elbow pain and related problems are commonly seen in doctors’ or physiotherapists’ general practice. Patient-rated questionnaires are a helpful tool in quantifying functional abilities and subjective feelings of patients who struggle with elbow problem. To the authors knowledge up to date there are no Polish versions of questionnaires related to elbow problems. Aim The purpose of this study is to translate and adapt four elbow questionnaires to suit Polish patients: Oxford Elbow Score (OES), American Shoulder and Elbow Surgeons-Elbow (ASES-E) and Mayo Elbow Performance Score (MEPS) and Summary Outcome Determination (SOD). This is initial phase and in the next, adapted questionnaires will be validated. Materials and methods Cultural adaptation of the selected questionnaires to the Polish culture has been conducted in five stages according to the international guidelines and was supervising by committee. Cultural adaptation process included translating each score from English into Polish, reversetranslation and testing of created version on a group of 30 people. Results There have been no major difficulties during cultural adaptation process. The only problem was certain words which had no equivalents in Polish. Testing of the prefinal versions did not bring any objections. Conclusions In conclusion, new Polish versions of OES, ASES-E, MEPS and SOD score will be very useful in elbow assessment, in daily practice of doctors and physiotherapists. They will help to unify evaluation of the patients and give a possibility of comparing the results of different treatment methods.

Treatment of ulnar coronoid process fracture via a modified anteromedial approach

To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

Purpose: The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC). Methods: We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications. Results: The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later.Conclusion: Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study.

BackgroundIntra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older.MethodsPatients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit.ResultsThe ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups.ConclusionsIn patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

Functional outcome following elbow release and hardware removal after bicolumnar fixation of distal humeral fractures

IntroductionIntra-articular fractures of the distal humerus are typically treated with bicolumnar plate fixation. Despite prompt and accurate reduction and fixation, there is a high rate of complications post-surgical fixation. The purpose of this study was to determine the indications, technique, and outcomes of patients who had undergone an elbow release and hardware removal following bicolumnar plate fixation for an intra-articular fracture of the distal humerus. MethodsPatients who had undergone an elbow release and hardware removal by a single surgeon following bicolumnar fixation of an intra-articular fracture of the distal humerus were identified. Patients were contacted to participate in a chart review and to return to clinic for a follow-up visit. Patients who returned for a follow-up visit completed the DASH (Disabilities of the Arm, Shoulder and Hand), the MEPS (Mayo Elbow Performance Score), and the SF-36. ResultsForty-two patients were included in the final analysis. The average time from the original injury to the elbow release procedure was 17.5 months. There was an improvement of 33° in the mean flexion-extension arc following the procedure (p<0.001). The mean DASH score was 21 (SD=19) and the mean MEPS score was 82 (SD=16). There was a high rate of post-traumatic osteoarthritis (n=30). Two patients underwent a total elbow arthroplasty (TEA). One patient sustained a re-fracture of the distal humerus, and subsequently underwent repeat bicolumnar fixation. There were four reoperations (10%): two patients had a revision release of contracture and two patients underwent a closed manipulation. ConclusionsIt appears safe to remove both plates and to re-intervene relatively early. There is a modest but consistent improvement in flexion-extension arc, and the re-operation rate is low. Although there is a high rate of post-traumatic arthritic change radiographically, TEA was rare, and elbow-based outcome scores were good, although not normal.

Functional outcomes after treatments for different types of isolated ulnar coronoid fracture: A protocol for systematic review.

Background:Optimal treatments for ulnar coronoid fracture have yet to be determined. We aimed to systematically review treatment efficacy assessed by functional outcomes of patients with isolated ulnar coronoid fracture.Methods:Medline, Cochrane Library, EMBASE, and Google Scholar were searched for studies reporting quantitative outcomes data after surgical treatment for isolated ulnar coronoid fractures up to July 16, 2019. Functional outcomes determined using disabilities of the arm, shoulder and hand score; Mayo elbow performance score (MEPS); and range of motion were systematically reviewed.Results:Six studies with a total of 65 patients with isolated coronoid fracture who had received surgical treatment were included. All studies were of good quality according to a modified Delphi checklist. Most patients had Type II fractures based on Regan-Morrey or O’Driscoll classification. Disabilities of the arm, shoulder and hand scores were reported by 2 studies (mean range 5–17). Four studies reported MEPS (mean range 89–98). One study reported Broberg-Morrey scores, in which 93% patients achieved excellent or good outcomes. Five studies reported range of motion, with mean flexion ranging from 122 to 137 and mean extension ranging from 4.0 to 21 degrees. Quantitative analyses revealed that lateral, medial, or posterior approaches in treating Type II fractures are associated with higher postoperative MEPS and flexion scores than the anteromedial approach.Conclusions:Treatment efficacy assessed by functional outcomes for isolated ulnar coronoid fractures is overall satisfactory. Whether lateral, medial, or posterior approaches lead to more favorable outcomes than the anteromedial approach is inconclusive. Further prospective studies are warranted.

Observational study of outcome of open reduction and internal fixation of supracondylar with inter condylar humeral fracture in patient above 18 years at tertiary care center of south Gujarat

Aim: To anayise functional outcome of surgical management of supracondylar with inter condylar humeral fracture. Materials and Method: We hereby report the outcome of a series of Intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Total 50 patients included in this retrospective study which include 36 male and 14 female. 39 patients were treated using Orthogonic platting and 11 patients were treated using parallel platting via posterior approach within 15 days of injury. Functional outcome was assessed via DASH (Disability of the Arm, Shoulder and Hand), MEPS(Mayo Elbow Performance Score) at 6 months. Results:At the end of 6 months flexion arc was 115 ± 6.79 in the orthogonal group while that in the parallel plating group was 112 ± 7.72. MEPS and DASH scores were 87.23 ± 7.75 and 24.23 ± 6.02 for the orthogonal group and 89 ± 8.07 and 23.18 ± 11.33 for the parallel plating group, respectively. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes or complication rates. Conclusion: The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function.